- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $977.24 / $3,890.45
| Facility | | $102.33 | $977.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $173.78 / $363.08
| Professional | | $74.13 | $173.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Professional | 50 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,258.93 / $2,137.96 / $2,951.21
| Facility | | $1,258.93 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $69.18 / $223.87
| Professional | | $57.54 | $69.18 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $87.10 / $104.71 / $338.84
| Professional | 50 | $87.10 | $104.71 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $104.71 / $134.90
| Facility | | $77.62 | $104.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $104.71 / $128.82
| Professional | | $85.11 | $104.71 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $144.54 / $1,318.26
| Facility | | $95.50 | $144.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $223.87 / $1,096.48
| Professional | | $87.10 | $223.87 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $66.07
| Professional | | $32.36 | $33.11 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $1,445.44 / $2,630.27
| Facility | | $389.05 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $309.03
| Professional | | $77.62 | $154.88 | $309.03 |